Camp App Staff | The Church of God – North Carolina State Office

Member of The Church of God?(Required)

Yes

We appreciate your willingness to help. At this time, please submit a camper application.

I will be attending as staff: (Must be 18 Years old or older.)(Required)

Yes

Name(Required)

First Last

I am able to attend International Youth Camp (IYC) if selected to be sponsored.(Required)

Yes

IYC dates TBD.

T-Shirts - $25(Required)

T-Shirts have to be pay for in advance.

Age(Required)

Please enter a number from 0 to 120.

Date of Birth(Required)

Current Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Gender(Required)

Male

Female

Phone(Required)

Email(Required)

Enter Email Confirm Email

Local Church(Required)

Signature

Spiritual Information

Saved?(Required)

Yes

Sanctified?(Required)

Yes

Holy Ghost?(Required)

Yes

Do you hold any positions as a church leader?(Required)

Yes

If yes, please list positions currently held.

Do you believe and practice the church teachings and advice as set forth by the General Assembly?(Required)

Yes

Are you willing to assume any responsibilities you may be placed in?(Required)

Yes

Will you abide by the rules of camp & encourage others to do the same?(Required)

Yes

Are you willing to forget about yourself & put the needs of campers first?(Required)

Yes

Can you be at camp on time & stay until released from duties?(Required)

Yes

Do you participate in your local church's activities consistently?(Required)

Yes

Will you attend camp meetings, if possible, for instruction & duties?(Required)

Yes

If you answered no to any of the above questions please explain why.

Have you ever been charged or convicted of a crime involving a minor or a crime that involved any sexual conduct?(Required)

Yes

The Following Must Be Answered & Signed To Be Able To Work In Camp (this is a requirement of the Insurance Company and is no reflection of The Church of God. All information received is confidential and is held at the State Office.) -The Authorization for Criminal Background Check MUST be completed if you have not previously filled one out. Contact Sis. Debbie for details.

Health Information

Health Conditions(Required)

Please check all that apply.

Allergic Reactions(Required)

Bee Stings

Drugs

Food(s)

None

Please give a more detail of what you are allergic to and your allergic reactions in the box below.

Additional Health concerns, allergies and/or limitations

If you checked any of the boxes other than NONE for the previous two questions please give details here. You may also add any additional details of concerns in this box.

Please list any prescribed medications you are taking

All medications is to be given to the camp nurse to administer to the camper unless approved by camp administration.

Insurance Information

Insurance Provider(Required)

Group Number(Required)

Policy Number(Required)

Emergency Contact(Required)

First Last

Relationship(Required)

Emergency Phone Number(Required)

Background Information

How long have you lived at your current address?(Required)

Previous Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Date of Birth(Required)

Driver's License #(Required)

Driver's License State(Required)

Signature - Type your signature.(Required)

Social Security Number(Required)

Payment Information

Tuition Amount(Required)

Staff - $50.00

(Staff do not qualify for family discount because they are already receiving a discounted rate.) SNACK SHACK will be open to purchase snacks/drinks. This is NOT included in the tuition. Snack Shack cards can be purchased in advance or at camp. ($5 per card) APPLICATION DEADLINE May 1, 2026 No applications after deadline unless extenuating circumstances occur and tuition will be $115.00.

Name for other members in your family attending.

Date